Depression is different from other illnesses in that, in addition to the physiological symptoms (loss of appetite, nervousness, sleeplessness, fatigue), there are the accompanying thoughts that can be so incredibly painful. For example, when myRaynaud’s flares up, the numbness in my fingers can be uncomfortable, but it doesn’t tell me that I am worthless, pathetic, and that things will never ever get better. During severe depressive episodes, however, these thoughts can be life-threatening: They insist that the only way out of the pain is to leave this world.

Being able to manage our thought stream will direct us toward health, as our thoughts are constantly communicating with the various systems of our body, either sending certain glands or organs an SOS in distress, or a note that everything is fine, resulting in calm. But being able to harness this craziness in the midst of depression and anxiety is so very difficult.

Here are some of the ways I try to let go of the thoughts that cause depression and anxiety. Some days I am much more successful than others.

Identify the Distortions

I have benefited immensely from David Burns’ book Feeling Good: The New Mood Therapy— from doing the cognitive behavioral therapy exercises he prescribes to identifying the various distortions in my own thinking that he presents in his book and his workbook. They include:

All-or-nothing thinking You look at things in absolute, black-and-white categories.

Overgeneralization You view a negative event as a never-ending pattern of defeat.

Mental filter You dwell on the negatives and ignore the positives.

Discounting the positives You insist that your accomplishments or positive qualities don’t count (my college diploma was a stroke of luck … really, it was).

Jumping to conclusions You conclude things are bad without any definite evidence. These include mind reading (assuming that people are reacting negatively to you) and fortune telling (predicting that things will turn out badly).

Magnification or minimization You blow things way out of proportion or you shrink their importance.

Emotional reasoning You reason from how you feel: “I feel like an idiot, so I must be one.”

“Should” statements You criticize yourself or other people with “shoulds,” “shouldn’ts,” “musts,” “oughts,” and “have-tos.”

Labeling Instead of saying, “I made a mistake,” you tell yourself, “I’m a jerk” or “I’m a loser.”

Blame You blame yourself for something you weren’t entirely responsible for, or you blame other people and overlook ways that you contributed to a problem.

It doesn’t take long to identify one or more of these in your thinking. Just recognizing these traps can be helpful. You might then try one of the methods listed in Burns’ 15 Ways to Untwist Your Thinking. A warning, though: I’d wait until you have emerged from a severe depressive episode before you attempt some of these exercises. I’ve made the mistake of trying too hard to “fix” my thinking during severe depression, which has made it worse. It’s better to focus on the other ways listed below.

Focus on the Present

Although every self-help book I read touches on this, I am just beginning to really learn what it means to focus on the present and to appreciate the healing power of mindfulness, which, according to meditation teacher and bestselling author Jon Kabat-Zinn, is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” If we continue to practice this, he explains, “this kind of attention nurtures greater awareness, clarity, and acceptance of the present-moment reality.” It’s not that we don’t feel the hurt, rage, and sadness that lives at the surface of our minds. It’s not an attempt to escape all the suffering that is there. But if we can observe all of our projections into the past and future — and all of the judgments that are part of our thought stream — and simply get back to what is happening right now, right here, we can allow a little room between our thoughts and our reality. With some awareness, we can begin to detach from the stories that we spin and from the commentaries that are so often feeding our pain.

One of the best ways we stay present is by keeping our attention on our breath. Vietnamese Zen Buddhist Thich Nhat Hanh instructs us that with each in-breath, we might say, “Breathing in, I know that I am breathing in.” And with each out-breath, “Breathing out, I know I am breathing out.” In his book You Are Here, he explains that mindful breathing is a kind of bridge that brings the body and the mind together. We start by this simple gesture of watching our breath, and then by this mindfulness of breath we begin to stich the body and mind together and generate a calm that will penetrate both.

Apply Self-Compassion

“Self-compassion doesn’t eradicate pain or negative experiences,” Kristin Neff, PhD, explains in her book Self-Compassion. “It just embraces them with kindness and gives them space to transform on their own.” It gives us the “calm courage needed to face our unwanted emotions head-on.” When I’m in the most pain — especially during a severe depressive episode — it is self-compassion more than anything else (cognitive behavioral therapy techniques, mindful breathing, etc.) that saves me and restores me to sanity. Nhat Hanh says that we should treat our depression tenderly, as we would treat a child. He writes:

If you feel irritation or depression or despair, recognize their presence and practice this mantra: “Dear one, I am here for you.” You should talk to your depression or your anger just as you would to a child. You embrace it tenderly with the energy of mindfulness and say, “Dear one, I know you are there, and I am going to take care of you,” just as you would with your crying baby.

It is so easy to be so cruel to ourselves without even realizing it. The ruminations that are part of depression beat us down and shred us until there is practically nothing there. That’s why it is so critical to apply self-compassion from the start, and treat ourselves, as well as our depression, as the scared little child that needs comforting, not scorn.

If the religious language bothers you, Eckhart Tolle says much the same when he writes in A New Earth:

Once you see and accept the transience of all things and the inevitability of change, you can enjoy the pleasures of the world while they last without fear of loss or anxiety about the future. When you are detached, you gain a higher vantage point from which to view the event in your life instead of being trapped inside them.

Absolutely everything, especially our feelings and emotions, is impermanent. By simply remembering that nothing ever stays, I am freed from the suffocating thoughts of my depression — the formidable fear that this sadness will always be with me, as well as the circumstances that are causing it. By acknowledging the transience of life, I am again called to pay attention to the present moment, where there is more peace and calm than I think.